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Fractional
photothermolysis
bridges
gap
between
ablative,
non-ablative
treatments.
Apr 1,
2005
By: Beth
Kapes
Cosmetic
Surgery
Times
The Fraxel
laser
resurfaces
the area
fractionally
and leaves
an 80
percent
reservoir
of normal
skin to
help the
healing
from
within.
(Photos:
Cameron K.
Rokhsar,
M.D.)
San Diego
— Could
nonablative
skin
rejuvenation,
as it is
currently
known,
suddenly
become
obsolete
for
cosmetic
surgeons
and their
patients?
With the
recent
introduction
of
fractional
photothermolysis
(Fraxel,
Reliant
Technologies),
it is
possible
that this
technology
will
replace
many other
nonablative
lasers due
to its
outstanding
abilities,
says
Cameron K.
Rokhsar,
M.D., who
is with
The New
York
Aesthetic
Center and
is
assistant
professor
of
dermatology,
Mount
Sinai
School of
Medicine.
"Among 150
patients,
throughout
a one-year
period
while in
San Diego
with
Richard
Fitzpatrick,
M.D., and
now in New
York, we
saw
dramatic
differences
when using
the Fraxel
for
texture
improvements
— the
changes
were
almost
immediate,
even after
one or two
treatments,"
Dr.
Rokhsar
says.
"The
Fraxel
laser also
helps
reduce
fine lines
and the
treatment
of
dyschromia,
but this
usually
takes four
to five
treatment
sessions.
We've also
recently
used it
for
melasma,
with
encouraging
results."
Speaking
here at
the
American
Academy of
Cosmetic
Surgeons
Annual
Scientific
Meeting (AACS),
Dr.
Rokhsar
presented
evidence
that
supports
use of
this
technology.
In
addition
to its
improvement
in
aesthetic
results,
the 1.5
micrometer
laser has
also
widened
treatment
parameters
to all
skin
surfaces,
without
the side
effects
commonly
seen with
more
powerful
resurfacing
lasers,
such as
the erbium
or the CO2
laser.
Another
potential
advantage
is the
ability to
treat
darker
skin types
IV and V.
"The
Fraxel
introduces
a new
paradigm
that we
haven't
used
before,"
Dr.
Rokhsar
says.
"This
innovative
fiber
laser
sySitem
produces
microscopic
thermal
wounds in
the skin
to achieve
facial
rejuvenation
that we
accomplish
fractionally,
15 to 20
percent at
one time,
with tiny
beams that
allow you
to dial in
the amount
of thermal
damage
precisely,
offering
us control
that we've
never had
before."
Getting
results
gently
Depending
on the
densities
and number
of passes,
the Fraxel
laser lays
down
arrays of
very small
microscopic
spots —
typically,
1,500 to
2,500 per
square
centimeter
— at a
pulse
energy of
six to 12
mJ per
microthermal
zone.
Fractional
photothermolysis
was
developed
by R. Rox
Anderson,
M.D.,
director
of Wellman
Laboratories,
in
collaboration
with
Reliant
Technologies.
Its
resurfacing
success is
based on
microscopic
treatment
zones (MTZs)
that are
passed
over with
the laser
repeatedly
over
several
consecutive
weeks.
"We've
found that
weekly
sessions
are more
effective
than
waiting
long
intervals
of time in
between
sessions,"
Dr.
Rokhsar
says.
"With
sessions
that are
10 to 30
minutes,
it's very
convenient
for the
patient,
and, in
the end,
they are
very
satisfied.
Some of
our
patients,
who had
been
treated in
the past
with other
nonablative
lasers for
acne scars
or
surgical
scars, are
seeing
much
better
results
with the
Fraxel."
An
additional
benefit is
the
ability to
use the
Fraxel on
areas
other than
the face.
For
instance,
the
freehand
erbium
laser is
very
tricky to
use off
the face
and in
such areas
such as
the neck
or chest,
due to
risk of
scarring.
The Fraxel
laser
allows the
cosmetic
surgeon to
treat any
surface of
the body
safely
with only
some
erythema,
which
resolves
in a
matter of
days,
according
to Dr.
Rokhsar.
"With the
CO2 laser,
you cannot
resurface
any deeper
than 300
to 400
microns or
you risk
scarring.
In
addition,
patients
experience
two weeks'
downtime
associated
with
full-thickness
wounds, as
well as
crusting,
swelling
and
oozing.
With the
Fraxel
laser, you
are
resurfacing
the area
fractionally
and, as a
result,
you have
an 80
percent
reservoir
of normal
skin to
help the
healing
from
within,"
Dr.
Rokhsar
says.
"Because
of this,
you can
potentially
resurface
as deep as
700
microns
with
minimal
risk of
scarring."
Initial
data
brought
forward by
Dr.
Rokhsar
captures
only 12
months of
treatment
time. Fine
lines
remain
improved
at one
year. The
improved
texture
also
persiSited
throughout
this time,
he says.
"I have
not seen
improvement
with
deeper
lines as
in the
treatment
with the
CO2 laser,
but you
cannot
truly
compare
this with
the Fraxel
— it's
like
comparing
apples to
oranges,"
Dr.
Rokhsar
says. "The
CO2 laser
remains in
a class of
its own,
producing
remarkable
and
consiSitent
results,
but is
associated
with
downtime
and
certain
adverse
risks
during the
healing
process.
Although I
have not
seen
results
similar to
the CO2
laser for
deeper
lines, it
may be
that we
need to
follow the
patients
for longer
periods of
time, as
collagen
remodeling
probably
continues
for
months.
Refinement
of the
treatment
parameters
may also
be
useful,"
he says.
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